Part B 01 Flashcards
1
Q
LBBB features
A
Qrs>120
Dominant s in V1
L axis deviation
Delayed 1st seg QR
2
Q
RBBB features
A
> 120ms qrs
RSR pattern in v1-3 (m)
Wide S wave
3
Q
Heat stroke definition
A
> 40c and CNS dys
4
Q
Asthma ABG only if
A
sO2 under 92%
5
Q
Lithotripsy when
A
Stone under 1cm diameter
6
Q
Staghorn calculus made from
A
Struvite
Mg ammonium phosphate
7
Q
GRACE scoring for
A
Mortality UA and Nstemi
8
Q
Trophoblastic disease includes
A
Molar preg and
Choriocarcinoma
9
Q
Ranson criteria
A
Acute panc
Wcc>16, age>55, glu>10, ast>250, LDH>350
10
Q
HHS dx
A
Hyperosm hypergly state
>350mmol osm
11
Q
CI thrombolysis
Stroke
A
> 4:5h
BP>180/110
Use labetalol/nitrate infusion
12
Q
Chadsvasc
A
CHF HTN Age>75 score 2 DM Stroke/tia score 2 Vasc ds Age 64-75 Sex female 1pt
13
Q
TCA OD
Sx start after what time
A
1-2h
14
Q
Syphilis organism
A
Treponema pallidum
15
Q
Tx syphilis
A
IM Procaine benzylpenicillin
10-14d
16
Q
Tx chlamydia
A
Doxy
Azithromycin
17
Q
Ix: microscopy and culture
Chlamydia
Vs
Gonorrhea
A
Chlamydia: No organisms, nil culture Vs Gonorrhea Diplococci, +ve culture
18
Q
Reactive arthritis
Aka
A
Reiters syndrome
19
Q
Reactive arthritis sx
A
Conjunctivitis, iritis
Urethritis, cervicitis
Arthritis
20
Q
Define preg induced HTN
A
Over 20/40
Over 140/90
Without protein in urine
21
Q
HELLP define
A
Haemolysis (high LDH)
Elevated liver
Low plt
22
Q
Complication of HELLP
A
Placental abruption
LF
RF
23
Q
Rovsings sign
A
Acute appendicitis
Palpate Left
Pain in Right
24
Q
MET (medical expulsive therapy) renal Stone
A
Alpha blockers or CCB
25
DC shock energies
Unstable tachy
Broad complex/ AF
A flutter/ narrow complex
Broad complex/ AF: 120-150
A flutter/ narrow complex:
70-125J
Then increase
26
DC shock energies
| Unstable tachys
```
Broad complex/ AF:
120-150
A flutter/ narrow complex:
70-120J
Then increase
```
27
High take off
| Aka
Benign early depolarisation
28
Cyanide Tx
Hydroxycobalamin
29
Heparin antidote
Protamine sulphate
30
Iron OD
| Tx
Desfurroxamine
31
Isoniazid OD
| Tx
Pyridoxine
32
Ethylene glycol OD
| Tx
Ethanol or fomepizole
33
Methanol OD
| Tx
Ethanol or fomepizole
34
Ethylene glycol/ methanol OD Tx
Ethanol or fomepizole
35
Organophosphate OD
| Tx
Atropine
36
Thallium OD
| Tx
Prussian blue
37
Salicylate OD Tx
1.26% sodium bicarbonate
38
Calculate anion gap
Na - (Cl + HCO3)
39
Normal anion gap
| Value
~5-15mmol
40
High anion gap value
~>15mmol
| Some sources suggest over 11
41
Causes of high anion gap acidosis
```
Catmudpiles
CO
Alcoholic ketoacidosis
Toluene
Metformin/ methanol
Uraemia
DKA
Propelyne glycol
Iron/ isoniazid
Lactic acidosis
Ethylene glycol
Salicylate
```
42
Torsade de pointe
| Tx
IV mg sulphate
43
Torsade de pointe
| Caused by
Long QT
44
Hypothermia arrest
| Changes to ALS
Check SOL for 1 minute
Avoid drugs or defib until over 30C
Double interval between drugs until nearing normothermia
45
Endocarditis Tx
Fluclox and gent
If pen allergic/ cardiac prosthesis or suspect MRSA:
Vanc, rifampicin, Gent
46
Steven Johnson’s syndrome
| Drugs and interval between taking and onset
Most Abx and NSAIDS
| Starts 1-3w after initiating drug
47
Wernickes encephalopathy
V
Korsakoffs psychosis
(Order events)
```
1st; Wernickes encephalopathy
(Conf, ophthal, ataxia)
V
2nd; Korsakoffs psychosis
(Confab, retrograde amnesia)
```
48
Diagnosis criteria
| Somatization disorder
```
Any 2:
Pain in 4 different sites
2 GI problems
1 sexual problem
1 pseudo neurological
```
49
Section 2
28d long
| Tx mental health disorder and sequela
50
Section 5 (2)
72h detain
| For MHA assessment
51
Section 136
Police detain for 72h ?24h
For MHA assessment
From public place to place of safety
52
Gout crystals appearance
Negatively berefringent
53
Ulnar/ medial border snuff box
Extensor pollicis longus
54
C-spine CT criteria
```
GCS<13
Intubated
X-ray inadequate
XR abnormal
CT of head as well
Or
Alert with clinical suspicion and
Over 65/ dangerous mech/ focal neuro/ paraesthesia/ >5stairs/ >1m/ axial load/ high speed/ roll over RTA/ ejection/ bicycle
```
55
Conscious sedation advice
```
Do not:
Drive
Operate machinery
Make important decisions
Drink for 24h
```
56
CT head criteria
```
GCS <13 on initial assessment
GCS<15 2h after injury
D. Skull #, basal skull #
Post traumatic seizure
Focal deficit
>1 vomit
```
57
Dissection
| Stanford classification.
A: ascending aorta -> surgery
B: not ascending -> medical management
58
Medical management aortic dissection
BP control
| Labetolol infusion
59
Causes of
| Prolonged QT
MI
Electrolyte disturbance
Congenital: Romano ward syndrome
Drugs
60
CAST #
Childhood associated spiral tibial #
| Spiral # distal third
61
Concerning inter arm BP difference
20mmHg
62
Calculate serum osmolality
2(k+Na) + urea + glucose
63
Diagnosis HHS
Hyperosmotic hyperglycaemic state
| Serum osm > 350mmol
64
Substance to test for ketones
3B hydroxybutyrate
65
Treatment of HHS
Fluids
| Ketone >1 -> start insulin
66
Causes of split S1
RBBB
LV pacing
Ebstein abnormality
67
DVLA on IDDM
| Includes
BG prior to journey w/i 2h
| BG every 2h whilst driving
68
Allowed to breach confidentiality if:
```
Legal obligation: notifiable ds
Court order
Risk to public
Risk to other
Requirement of body (DVLA)
```
69
Pregnancy and flying
Single preg <36/40
| Multiple <32/40
70
Fitness to fly certificate
In pregnancy
When required and what to write
>28/40
Write :
Normal preg, no comps, due date
71
To take consent for procedure
| You must have
Training for consent
Knowledge of procedure
Understand risk/benefit
72
Echo de la pensee
Seen in
Aka
Thought echo
| Seen in schizophrenia
73
Sad persons score and management
0-5: ?safe discharge
6-8: ?psych consultation
>8: ?hosp admission
74
Sad persons
| Criteria
```
Sex: male
Age <25>59
Depression (2)
Previous attempt or psych care
Etoh/drugs
Rational thinking loss (2)
Single
Organised attempt (2)
No social input
Stated future intent (2)
```
75
Cardiac tamponade signs
Becks triad
Distended neck veins
Muffled HS
Hypotension
76
Posterior dislocation shoulder
| How
Forced posterior
| In internal rotation and abduction
77
Complication
| Posterior dis shoulder
Revere hill Sachs
Reverse bankart lesion
HAGL lesion
#lesser tuberosity
78
HAGL lesion
Comp post dislocation shoulder
| Humeral avulsion glenohumeral lig
79
Pulled elbow
| What structures effected
Subluxed radial head
At proximal radioulnar joint
Torn annular lig
80
Manipulation
| Pulled elbow
2 methods
1) hyperpronation
2) supination and flexion
81
Posterolateral elbow dislocation
| Complications
Ulnar/ median nerve
Brachial artery
Medial epicondyle #
82
Posterolateral elbow dislocation
| Manipulation
Pronate
Flex at 60 deg
Pull
83
Levels of sedation
| ASA
Minimal: anxiolysis
Moderate: conscious sedation: respond voice
Deep: painful stimuli
General anaesthesia: unrousable
84
Deep sedation
| monitoring
ECG
NIBP
Pulse ox
Capnography
85
Dry socket syndrome
| Aka
Alveolar osteitis
86
Trauma chest drain
| Size
36F
87
Optimal chest drain site
5th intercostal space
| Anterior to mid axillary line
88
Tetanus Ig
| Give if
High risk wound and
Unknown immunisation
Under 3 doses vaccine
>5 yrs since last dose
89
Tetanus Ig dose
250-500 IU
90
Flaccid
Vs
Spastic bladder
Flaccid: T12
“Reflex bladder”
Cannot sense filling, but reflex emptying
91
Mannitol dose
1g/kg
92
Mannitol
| Used to Tx
High ICP
Glaucoma
Diuretic
Rhabdomyolysis
